Post RALP Path Upgraded

I'm officially in the club at 48 yr old. You can see from my signature I have 11 out of 12 cores positive for adenocarcinoma and positive DRE. My CT scan and bone scan came back negative therefore my clinical stage is or should I say was T2A with a PSA of 5.15. RALP performed on 5/5/17 with no major complications and bilateral nerve sparing. The entire procedure took a little over 2 hours. The cath was removed on 5/12/17 and the doctor went over what I consider a disappointing path report. It turns out not to be my last chapter, but the beginning of another. I sure prayed before hand the surgery was going to give me the "cure". However, that wasn't the case and I saw for the first time fear in the eyes of my wife; we have a 10 year old child. Here is my post op report data:

- Gleason Score 4+3 , minor tertiary pattern 5 <5%, gleason 4 70%, grade group 3, left & right sides
- EPE, focal, right posterior
- PSM, extensive including bilateral apical margins & right posterior prostate >3 mm
- Bilateral SV's negative
- PNI present
- 40% prostrate gland involved
- Path stage pT3A,NO
- other path high grade prostatic intraepithelial neoplasia, focal.
benign fibro muscular and glandular hyperplasia, mild
- Left & Right pelvic lymph nodes (7) negative

Comments: Both the left and right sides of prostate, and approximately 40% of sampled tissue show adenocarcinoma of prostate. The predominant Gleason pattern is 4+3=7 with minor tertiary pattern 5; other patterns of Gleason 3+3 and 3+4 adenocarcinoma are also present. There is extensive, broad front margin positivity involving both right and left apical margins and the right side of the prostrate. There is focal extraprostatic extension on the right side.

Not sure what all this means, but the doctor says, "We're going at this now with a full court press." He has already set me up with a radiation oncologist for adjuvant radiotherapy regardless of PSA reading beginning sometime in August. My first post op PSA will be June 16th.

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3/1/17 PSA 5.3
3/16/17 PSA 5.15 & BIOPSY
3/21/17 Biopsy Results as follows:
A. Lft Apex 3+4 75% (10% 4)
B. Lft Mid 3+3 70% PNI
C. Lft Base 3+3 8%
D. Lft Lat Apex 3+3 25%
E. Lft Lat Mid 3+3 10%
F. Lft Lat Base Benign
G. Rht Apex 3+3 20%
H. Rht Mid 3+4 60% (5% 4)
I. Rht Base 3+3 40%
J. Rht Lat Apex 3+3 20%
K. Rht Lat Mid 3+4 20% (10% 4) PNI
L. Rht Lat Base 3+3 2%

Post Edited (randrball1) : 5/18/2017 9:52:58 PM (GMT-6)

Hello randrball. None of us like that feeling when our path reports comeback with an upgrade. There is that shock of what does all of this mean! You are in a very good place to increase your knowledge base which has the potential of lowering your fear level. Your doctor has you on the standard track of care for your report. Many of us have been down the road of some form of adjunct or salvage radiation. For most the side effects are negligible. You comment that you had prayed for your situation. I join with you in that prayer today for healing, wisdom, hope and destruction of the disease. Keep us posted on your steps along this road. I am nearly ten years out from surgery. Had upgraded path report and am doing fine. I would explore going to a cancer center of excellence for follow-up treatment. Where do you live? Others will come along and join the conversation.Blessings

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Diagnosis in August 2007
Age 57
PSA 4.1 Gleason 3+4=7
Robotic Surgery - 10/2007
GS 3+4=7, Stage T3a N0 MX, Margins-, EPE +, PIN+, Nodes-
Post- Surgery PSA .005, Jan. 2015 .06
SRT ended 5/15/15. 35 treatments 70 Gy's 8/1/'15 PSA <.006 11/1/2015 <.006 5/2016 <.006. 12/2016 <.006

Sorry you're a new member of our club And "welcome" to the"upgrade" club - my biopsy was graded as a 3+3, re-read by MD Anderson as a 3+4 and then upgraded to a 4+3 after RALP with a positive node as an extra credit bonus.

I think your Doc is on the right track taking your treatment to the next level. You will need to heal for a few months before radiation. I doubt if they will recommend ADT (Lupron) so hopefully you can avoid that train wreck.

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DX - 1-13-2015 (age 66) -- PSA 4.02 (9-16-2014) to 4.38 (12-5-2014)
RALP on March 2, 2015
G6 to G7(3+4) to G7(4+3)
Stage pT3aN1
11/2016 PSA < 0.01
7/31/2015 HT - six month's injection of Lupron
ART 11/2015, 33 sessions

Hi Rand... I would ask about starting ADT (hormone therapy) NOW to stop any possible spread while you wait for radiation treatment. Also, find and talk to a good Radiation Oncologist ASAP and get his opinion..he will be the one to prescribe the ADT...You want to be healed from the surgery before you start the radiation..Especially any incontinence issues should be resolved before you start radiation..If you have not consulted with a Medical Oncologist, now would be a good time to do so..At this point, your urologists role becomes secondary....Hang in there ! You can still beat this thing !

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Age now 74 . Diagnosed G-9 6/2010
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT. 2-15-'11 PSA <0.1 10/'11, <0.1 2/12, <0.1, 4/12 <0.1, 9/12, 0.8 3/13, 0.5 6/13, 1.1, back on HT. 5/16 stay the course, Lupron, Zytiga, PSA <0.1 10/16 no change <0.1 5/17 PSA 1.6 Chemo or Provenge next..

Do they really recommend HT even if PSA would be undetectable at, let say, 8 weeks? I would believe that deciding about adding HT or not could be done after the result from the PSA tests post surgery.

Gemlin-

The decision to add adjuvant HT doesn't just depend on PSA. Higher Gleason scores (the presence of any pattern 5 especially), and known significant high grade positive margins, stage 3/4, are all prognostic for worse outcomes, and long-term HT should be considered as part of it.

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Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
•SBRT 9 yr onc. results •SBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

HI randrball1,
I am pretty much same as you. Thanks for sharing. I will let you know how mine goes. Is there a 4+3 thread.
I am new to this but HT in the interim looks logical path.

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Age 48 Years Old
PSA 03/15 4.45 DRE: Firm Right Base
2 Weeks of Cipro
PSA 04/01 3.2
04/18 Biopsy
Right Base 4+3 ( 80% . 60%, 40%)
Right Middle 3+4 (75%, 50%, 25%)
Right Apex: HPIN
Left Base: Negative
Left Middle: Negative
Left Apex: Negative
RLAP scheduled for 05/26

Post Edited (ddyss) : 5/21/2017 9:35:53 AM (GMT-6)